A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 3: Core Elements of HIV Primary Care
Chapter 3:
Core Elements of HIV Primary Care
INITIAL EVALUATION
ONGOING CARE
KEY POINTS
SUGGESTED RESOURCES
John McNeil, MD
John V. L. Sheffield, MD
John G. Bartlett, MD
3
INITIAL EVALUATION
What are the goals of the initial evaluation?
The goals will depend to a large extent on why the
patient is being seen by the primary care provider,
which may be because of symptoms, the need for
evaluation after a positive HIV test, referral, for a
consultation, etc. The initial evaluation should be
tailored to the patient’s specific need, but the following
are the usual goals of the initial evaluation:
• Evaluate HIV-related complaints that require
immediate intervention
• Establish a strong patient-provider relationship with
clear lines of communication
• Initiate a complete medical database (Table 3-1)
• Assess the patient’s understanding of HIV disease
• Identify health needs for current medical problems,
including those associated with mental health,
substance abuse, hepatitis, and hypertension
• Assess the need for social and psychological
intervention
• Assess the need for consultants for medical, social, or
psychiatric care
• Describe HIV disease in lay terms, including natural
history, laboratory tests (CD4 cell count and viral
load), complications, treatment, and outcome
• Describe methods of transmission and of prevention
This is a large menu, and there may need to be several
“first visits.”
What are the important aspects of the initial
evaluation in patients with symptoms?
It is critical to learn quickly if the patient has any HIVrelated
complications that indicate advanced disease
and may require rapid intervention. The most common
presentations related to earlier HIV disease are
thrush, weight loss, skin lesions of Kaposi’s sarcoma,
Pneumocystis carinii pneumonia (PCP), and fever.
Patients with HIV can also have medical conditions
that stem from other causes, such as headaches,
upper respiratory infections (URI), gastroesophageal
reflux disease (GERD), hypertension, diabetes, or heart
disease. Distinction between these and conditions that
are HIV-related may be obvious, but when not, the best
laboratory test is a CD4 cell count, which represents
the barometer of immune function with HIV infection.
Nearly all HIV-related complications occur when the
CD4 cell count is